Tetanus containing vaccine
Onset of symptoms after vaccination
Tetanus toxoid (1962,1971,1976)
First episode: three weeks
First episode: Progressive limb weakness. CSF was normal except a protein level of 300 mg/dL.
Symptomatic treatment and physical therapy.
First episode: Complete recovery after two months.
Second episode: two weeks
Second episode: Tingling and numbness, mild weakness, loss of position sense, absent DTR. CSF was normal except a protein level of 250 mg/dL.
Second episode: Recovery after eight months with slight hand tremors.
Third episode: 10 days
Third episode: Tingling and numbness, unable to walk, loss of position sense and diminished pin prick sensation below knees.
Third episode: Patient had only mild hand weakness by day 12.
Tingling and numbness, profound weakness of the extremities, bilateral peripheral facial paresis, bulbar weakness, bilateral weakness of ocular abduction. DTR were absent. Touch and pin prick sensation were diminished distally in lower extremities. Vital capacity was 1.6 L. CSF protein level was 550 mg/dL, no pleocytosis.
Symptomatic treatment and physical therapy
Discharge after 57 days with mild left leg weakness.
Tingling of finger tips and toes, moderate weakness of four extremities. DTR were absent at ankles, knees and triceps. There was bilateral facial weakness and dysphagia. Position and vibration sense was diminished distally in four extremities. CSF protein level was 70 mg/dL.
Intravenous immunoglobulin and physical therapy
Significant improvement at six weeks. Residual facial weakness and painful twitching in both arms.